Signs of a sleep disorder

Could you have a sleep disorder?

Are you spending enough time in bed and still wake up tired or feel very sleepy during the day, you may be one of the estimated 40million Americans with a sleep disorder.

The most common sleep disorders are insomnia, sleep apnea (sleep–disordered breathing), restless legs syndrome , and narcolepsy. Although sleep disorders can significantly affect your health, safety, and well–being, they can be treated.

Talk to your doctor if you have any of these signs of a sleep disorder:

• You consistently take more than 30 minutes each night to fall asleep.

• You consistently awaken several time each night and then have trouble falling back to sleep, or you awaken too early in the morning.
  

• You often feel sleepy during the day, you take frequent naps, or you fall asleep at inappropriate times during the day.
  

• Your bed partner says that when you sleep, you snore loudly, snort, gasp, make choking sounds, or stop breathing for short periods.
  

• You have creeping, tingling, or crawling feelings in your legs or arms that are relieved by moving or massaging them, especially in the evening and when trying to fall alseep.
  

• Your bed partner notices that your legs or arms jerk often during sleep.
  

• You have vivid, dreamlike experiences while falling asleep or dozing.
  

• You have episodes of sudden muscle weakness when you are angry or fearful, or when you laugh.
  

• You feel as though you cannot move when you first wake up.
  

Keep in mind that children can have some of these same signs when they have a sleep disorder, but they often do not show signs of excessive daytime sleepiness. Instead they may seem overactive and have difficulty focusing or doing their best in school.

Source: U.S. Department of Health and Services, National Institutes of Health
http://www.medicinenet.com/sleep/page4.htm

Good night's sleep: 13 tips to help you

Get a good night's sleep

Like eating well and being physically active, getting a good night's sleep is vital to your well–being.

Here are 13 tips to help you:

Stick to a sleep schedule. Go to bed and wake up at the same time each day—even on the weekends.

Exercise is great but not too late in the day. Avoid exercising closer than 5 or 6 hours before bedtime.

Avoid

caffeine and nicotine. The stimulating effects of caffeine in coffee, colas, teas, and chocolate can take as long as 8 hours to wear off fully. Nicotine is also a stimulant.

Avoid alcoholic drinks before bed. A "nightcap" might help you get to sleep, but alcohol keeps you in the lights stages of sleep. You also tend to wake up in the middle of the night when the sedating effects have worn off.

Avoid large meals and beverages late at night. A large meal can cause indigestion that interferes with sleep. Drinking too many fluids at night can cause you to awaken frequently to urinate.

Avoid medicines that delay or disrupt your sleep, if possible. Some commonly prescribed heart, blood pressure, or asthma medications, as well as some over-the-counter herbal remedies for coughs, colds, or allergies, can disrupt sleep patterns.

Don't take naps after 3 p.m. Naps can boost your brain power, but late afternoon naps can make it harder to fall asleep at night. Also keep naps to under an hour.

Relax before bed. Take time to unwind. A relaxing activity, such as reading or listening to music, should be part of your bedtime ritual.

Take a hot bath before bed. The drop in body temperature after the bath may help you feel sleepy, and the bath can help relax you.

Have a good sleeping environment. Get rid of anything that might distract you from sleep, such as noises, bright lights, an uncomfortable bed, or a TV or computer in the bedroom. Also, keeping the temperature in your bedroom on the cool side can help you sleep better.

Have the right sunlight exposure. Daylight is key to regulating daily sleep patterns. Try to get outside in natural sunlight for at least 30 minutes each day.

Don't lie in bed awake. If you find yourself still awake after staying in bed for more than 20 minutes, get up and so some relaxing activity until you feel sleepy. The anxiety of not being able to sleep can make it harder to fall asleep.

See a doctor if you continue to have trouble sleeping. If you consistently find yourself feeling tired or not well rested during the day despite spending enough time in bed at night, you may have a sleep disorder. Your family doctor or a sleep specialist should be able to help you.

http://www.medicinenet.com/

Mental Illness: Long-Term Employment Trajectories

Long-Term Employment Trajectories Among Participants With Severe Mental Illness in Supported Employment

Deborah Becker, M.Ed., Rob Whitley, Ph.D., Edward L. Bailey, M.S. and Robert E. Drake, M.D., Ph.D.

OBJECTIVE: The long-term trajectories of participants in supported employment have not been clear. This exploratory study presents eight- to 12-year employment trajectories among adults with psychiatric disabilities who participated in supported employment.
METHODS: We reinterviewed 38 of 78 participants (49%) with severe mental illness eight to 12 years after they enrolled in supported employment studies in a small urban mental health center in New England. Data were analyzed by using quantitative and qualitative methods.
RESULTS: All 38 participants worked during the follow-up period, a great majority (82%) in competitive jobs, and 71% worked for more than half of the follow-up years. Participants reported numerous benefits related to employment, including enhancements to self-esteem, relationships, and illness management. Psychiatric illness was the major barrier to work; part-time employment and long-term supports were the major facilitators. Three overlapping themes emerged from the qualitative analysis as significant perceived influences on participants' work-related behavior. First, the successful management of symptoms and the deployment of appropriate coping skills appeared to play an important role in finding and maintaining work. Second, participants generally preferred to work part-time because of the lesser demands of this type of job and because it was perceived to allow for the maintenance of Social Security and health care entitlements. Third, participants saw the importance of ongoing individual placement and support services. Participants stated that this was imperative in making successful transitions between jobs or from unemployment to employment and in helping negotiate pay raises or changes in conditions.
CONCLUSIONS: The long-term trajectories of participants in supported employment programs, both vocational and nonvocational, appear to be positive.

Psychiatr Serv 58:922-928, July 2007
© 2007 American Psychiatric Association
http://psychservices.psychiatryonline.org/

National Survey of Children With Mental Illness

A National Survey of State Licensing, Regulating, and Monitoring of Residential Facilities for Children With Mental Illness

Judith L. Teich, M.S.W. and Henry T. Ireys, Ph.D.

OBJECTIVE: Little national information is available to help policy makers understand the methods that states use to regulate residential facilities for children with mental illness. This article describes the results of a government-sponsored survey of state officials that examined how states license, regulate, and monitor such facilities.

METHODS: Questionnaires were mailed to selected officials in each of the 50 states and the District of Columbia, followed by extensive telephone and e-mail contacts. Questionnaire items covered program characteristics, licensing and accreditation, mandated services, monitoring and oversight methods, and payment sources.

RESULTS: Information was gathered on 71 types of residential facilities in 38 states, accounting for 3,628 separate residential facilities with 50,507 beds as of September 30, 2003. States differed widely in the types of residential facilities that they regulate and their mix of regulatory methods, which included requirements for announced and unannounced visits, mandated staff-to-client ratios, minimum levels of education for facility directors, specifications for licensing practices and critical incident reporting, mandated complaint review procedures, and accreditation from designated organizations. Welfare, mental health, and health departments all participated in regulating facilities.

CONCLUSIONS: States relied on at least several regulatory methods, but no state used all of the possible methods. The regulatory environment is complex in most states because several agencies are involved in licensing, regulating, and reviewing complaints. To ensure that residential facilities effectively address the needs of children with mental illness and their families, policy makers should review and improve their state's data on methods for regulating residential facilities.

Psychiatr Serv 58:991-998, July 2007
© 2007 American Psychiatric Association
http://ps.psychiatryonline.org/

Treatment-Refractory Schizophrenia

Adding or Switching Antipsychotic Medications in Treatment-Refractory Schizophrenia

Julie Kreyenbuhl, Pharm.D., Ph.D., Steven C. Marcus, Ph.D., Joyce C. West, Ph.D., M.P.P., Joshua Wilk, Ph.D. and Mark Olfson, M.D., M.P.H.

OBJECTIVE: This study compared patients with schizophrenia whose antipsychotic medications were switched to manage treatment-resistant positive psychotic symptoms with those for whom another antipsychotic was added. Psychiatrists' characteristics and perceptions of effectiveness of the medication change on clinical outcomes were also reported.
METHODS: Psychiatrists participating in a nationally representative mailed survey (N=209) reported on the clinical features, management, and response to the change in antipsychotic medication (added versus switched) of one adult patient with treatment-refractory schizophrenia under their care for at least one year.
RESULTS: Thirty-three percent of patients were treated with an added antipsychotic medication. Compared with patients whose antipsychotic medications were switched, those with an added antipsychotic medication were more likely to be female, to have received care from the same psychiatrist for more than two years, and to have been recently prescribed an antidepressant. Compared with psychiatrists who switched antipsychotic prescriptions, those who added an antipsychotic reported that the change was less likely to reduce positive symptoms, improve functioning, and prevent hospitalization. Psychiatrists who added rather than switched antipsychotics reported more frequent attendance at educational programs sponsored by a pharmaceutical company.
CONCLUSIONS: Consistent with other lines of research and practice guideline recommendations, psychiatrists perceive antipsychotic polypharmacy to be a generally ineffective strategy for treatment-resistant positive psychotic symptoms. In light of these findings, efforts to identify and implement more effective evidence-based pharmacologic approaches should be undertaken.

Psychiatr Serv 58:983-990, July 2007
© 2007 American Psychiatric Association
http://ps.psychiatryonline.org/